Monday, February 6, 2017

Shoulder arthroplasty - how can a surgeon use two ORs?

Concern about an individual surgeon being responsible for two concurrent surgeries has led to increased scrutiny of the practice of a surgeon ‘running multiple operating rooms’.

These authors have proposed some useful definitions to guide our practice an understanding.

They define:

Turnover time (TT) as the time from when one patient leaves an operating room until the next patient enters.
Anesthesia positioning time (APT) is the time from when the patient enters the operating room until the incision takes place.
Surgical time (ST) is the time from incision to wound closure.
Conclusion time (CT) is the time from wound closure until the patient leaves the operating room.

They reviewed these times for 1062 of their shoulder arthroplasties and found

In such a case, the sum of TT, APT, and CT is 99 minutes, 24 minutes less than the 123 minute ST. With a 24 minute stagger, one surgeon could be present for 100% of the ST in each of two different rooms. No part of the cases in the two rooms would be ‘concurrent’ as shown in the plot below.

Comment: These data come from high volume practices that may not apply to other settings. Yet the definitions are useful and can be applied to any surgical venue to determine the value of allowing an individual surgeon to use two operating room on the same day. In a practical sense, if the surgeon knows the turnover and anesthesia positioning times, the stagger can be adjusted so that the start of conclusion time in one room coincides with the start of surgical time in the other.

The Boston Globe recently published a rather lengthy but riveting piece entitled
"CLASH IN THE NAME OF CARE" (see this link), which they describe as "a battle pitting a star surgeon against a great hospital, MGH. The question: Is it right or safe for surgeons to run two operations at once? Is it right that their patients may have no idea? The conflict went on for years. And it isn’t over yet."

There was a followup piece regarding a statement from the American College of Surgeons (see this link).

Comment: This is important, because it cuts to the trust a patient has in the person he or she has chosen to to the surgery.

The basic principle is that a surgeon cannot be involved in the critical part of two cases at the same time.